BackgroundAortic atresia with ventricular septal defect is a very rare congenital cardiac anomaly, especially in combination with aortic arch interruption. It is always challenging to choose the optimal treatment tactics for such patients. One of the possible types of intervention is the Yasui procedure. There are only 19 reported cases in the literature of aortic atresia with interruption of the aortic arch type B or C, and not a single clinical case of type A.Case presentationThe proband was a 2-day-old boy with diagnosis: aortic atresia with a ventricular septal defect and interruption of the aortic arch type B. The child underwent a Yasui procedure without serious postoperative complications and with good long-term result.ConclusionsThe Yasui procedure in patients with aortic atresia and interrupted aortic arch can be performed with minimal complications, even in low-weight patients.

Introduction . Transcatheter pulmonary valve implantation is one of the most relevant issues in endovascular surgery for congenital heart defects. However, at present, there is no “ideal” valve for transcatheter implantation. Balloon-expandable pulmonary valves for transcatheter implantation have a rigid frame, which requires pre-stenting of the native right ventricular outflow tract or the valve-containing conduit to avoid perioperative complications. This tactic increases the procedure time, complicates the valve implantation technique, and raises the cost of the operation. Self-expanding valves, which are primarily aimed at addressing pulmonary regurgitation, present an alternative. Determining an adequate implantation zone for the valve is crucial for the successful treatment of a dilated native right ventricular outflow tract. This is why preoperative CT imaging protocol, with 3D reconstruction providing detailed anatomical structures at every level, plays a significant role. Aims . To assess the properties of the transcatheter self-expanding frame of the pulmonary artery valve and to perform its in vitro implantation in a 3D model of a patient with right ventricular outflow tract dysfunction. Material and Methods. We developed a model of a self-expanding nitinol frame for a transcatheter valve for implantation in the position of the pulmonary artery, based on the most commonly encountered anatomy of right ventricular outflow tract dysfunction. We conducted tests for radial forces of the frame and valve loading trials in the delivery system. Results. A 3D reconstruction of the right heart chambers with the inferior vena cava was performed, with detailed anatomical structure delineation at each level. A 3D model was printed on an SLA 3D printer, Formlabs Form 3B+, using Elastic 50A photopolymer (Formlabs Inc., USA). Under fluoroscopic guidance, a test implantation of the pulmonary artery valve frame was carried out. Conclusion . By optimizing the design of the supporting frame, we were able to improve the transcatheter valve frame model based on the analysis of the most common right ventricular outflow tract dysfunctions. 3D-printed constructs enable the safe testing of developing transcatheter valve models and help identify and timely address any existing deficiencies.

Background. In clinical practice, MRI pathophysiological and pharmacokinetic models with calculations of contrast transport indicators are unacceptably little used.Aim of the study. To propose a pharmacokinetic technique for the quantitative assessment of primary tumors and metastases, the effectiveness of breast cancer chemotherapy (BC), from dynamic contrast enhancement MRI. Material and methods. 18 patients were included who underwent neoadjuvant chemotherapy (NACHT) in four cycles for breast cancer T1-3N0-1M0, followed by radical surgical removal of the tumor. According to the results of a three — year follow-up, patients with a relapse — free course (n = 11) formed group 1, and seven patients with detected metastatic lesions (3 in the liver, 2 in the lungs, 2 in the brain) — group 2. For the initial 120–180 s of MRI with contrast after the injection of a paramagnetic, the simplification is valid for concentrations in tumor and blood and for tranfer coefficient: d{СОПУХОЛЬ(t)} / dt = ККр-Оп * СКРОВЬ (t) , from which it is obvious: ККр-Оп = (СОПУХОЛЬ(Т)) / (∫CКРОВЬ(t) dt), which was used in all calculations of the contrast transfer constant. Gadobutrol contrast is 0.1M/10 kg of body weight, TR = 5.5–6 ms, TE = 2.5 ms. Results. If, after the first cycle of NACHT, the ККр-Оп of the primary breast cancer is < 0.22 ml/min/g of tissue, the probability of subsequent relapse-free course = 0.78. Similarly, a decrease in the KCr-Op Ккр-Оп of the sentinel lymph node after the first cycle of NAHT < 0.08 ml/min/g of tissue with a probability of 0.75 predicts a relapse-free course. Conclusion. The proposed method for calculating the ККр-Оп transfer coefficient allows obtaining additional diagnostic and prognostic information in patients with local and locally advanced forms of breast cancer.

Purpose: Since currently there are no selective drugs for paramagnetic contrast enhancement (PMC) in MRI in the oncology clinic as such, we tried to obtain a selective oncotropic paramagnetic contrast agent (PMCA) – Mn(II) manganese compound with glucaric acid (used in combination with 99mTc for breast cancer (breast cancer), and to evaluate on the basis of animal studies the possibility of using Mn(II)-glucarate (Glucaromang) as an oncotropic PMCA in breast cancer. Material and methods: The synthesis of glucaric acid was carried out by a modified method by oxidation of D-glucose with strong nitric acid. A solution of D-glucaric acid was used to produce manganese glucarate by combining with manganese oxide or carbonate with an excess of glucarate in solution, since one manganese atom forms a complex with two glucaric acid molecules. The injection solution of the obtained Mn(II)-glucarate was adjusted to pH = 6.4–7.2 and sterilized by microfiltration through Millipore filters with a pore size of 0.22 μm. The toxicity indices LD10, LD50, LD90 (ml/kg) were determined in laboratory white mice. An in vivo MRI study of the tumor accumulation of Mn(II)-glucarate was performed in veterinary patients – cats (n = 9) with diagnosed breast cancer, who underwent body MRI to clarify the diagnosis and assess the extent of breast cancer, and 4 cats with malignant tumors of the neck and submandibular region (salivary glands). Scanning was performed using Toshiba Titan Vantage (Canon Medical) and Magnetom Open (Siemens Medical), with subsequent processing by Radiant (https://www.radiantviewer.com ). Results: In the injection solution of Mn(II)-glucarate 0.5 M, free manganese was absent in detectable amounts, the excess of glucaric acid (has an antineoproliferative effect) was up to 2–2.5 %. Osmolality 1550±39 mOsmol/(kg H2O), viscosity 2.85±0.15 MPa·s, at 37 °C. When stored for 6 months, there was no release of manganese from the complex. The thermodynamic stability constant was 17.6–17.9. For the injection drug «Mn(II)-glucarate, 0.5M, aqueous solution”, the mortality rates for single administration in mice were, respectively: LD10 = 6.8 ± 5.0 ml/kg, LD50=15.1 ± 4.7 ml/kg, LD90=37.5 ± 23.8 ml/kg . When administered Mn(II)-glucarate as laboratory mice and cats with breast cancer did not show significant changes in the blood pattern and any side effects. The drug accumulated intensively in the primary tumor and metastases. The index of enhancement for T1-WI was 1.78 ± 0.082 (p < 0.02) for the primary tumor and 1.49 ± 0.09 (p < 0.05) for lymphogenic metastases. Conclusion: Mn-glucarate is an original paramagnetic contrast agent, highly stable, non-toxic, providing in vivo intensive MRI imaging of tumor structures, in particular in breast cancer.

Цель. Провести сравнительный анализ эффективности использования различных методов лучевой диагностики (эхокардиография (ЭхоКГ), компьютерно-томографическая ангиография (КТА), магнитно-резонансная томография (МРТ)) в оценке особенностей корня аорты у пациентов с выраженным аортальным стенозом для улучшения процессов биотехнического проектирования при разработке новых моделей искусственного аортального клапана (АК).

Kommerell's diverticulum causes compression of the esophagus, trachea and laryngeal nerve between the aberrant mouth of the left subclavian artery and ascending aorta. This leads to dysphagia or shortness of breath. We describe hybrid treatment of the right aortic arch with Kommerell's diverticulum and giant aneurysm of the aberrant left subclavian artery.

Актуальность. Отсутствие стандартов при выборе метода хирургической реваскуляризации стенозов сонных артерий и объективных методов оценки предикторов эмболических осложнений определяют необходимость поиска диагностических алгоритмов для оптимизации лечебной тактики.

The aim of the study was to identify new anatomical landmarks of the aortic root and the relationship between the sizes of anatomical structures using the method of computed tomography angiography to improve models of heart valves and the methods for their selection in clinical practice.Materials and Methods:The dataset of computed tomography angiography prior to aortic valve replacement in 262 patients was analyzed. The mean age was 75.0±5.9 years. 99 (37.8±3.0%) men and 163 (62.2±3.0%) women took part in the study. The annulus fibrosus, sinotubular junction, and height of the sinuses of Valsalva were measured.Results:In the tricuspid aortic valve group (n=251), in more than 50% of the cases, the diameter of the annulus fibrosus ranged from 23 to 26 mm. No significant association between the diameter of the annulus fibrosus and patient height (r=0.35; p=0.01) or body surface area (r=0.25; p=0.01) and the height of the sinuses of Valsalva (r=0.34; p=0.01) were revealed. Based on the ratio of the height of the sinuses of Valsalva and the diameter of the annulus fibrosus, three variants of the structure of the aortic root were identified: type A - K>1.05; type B- 0.95≤K≤1.05; type C- K<0.95. Type C of the aortic root was found to predominate in most cases, namely, in 98.0±0.9% (n=246).In the bicuspid aortic valve group (n=11), 2 patients had a type A of the aortic root, 1 patient had a type B, and 8 patients had a type C.Conclusion:A classification of variants of the aortic root structure has been proposed, which will be useful not only for practitioners when choosing a treatment method, but also for researchers to understand the structural characteristics of the aortic root in patients with its pathology.

Purpose. To establish the methods for estimating the volume of the true and false aortic canals applying computed tomography angiography (CTA) to a clinical case with hybrid stent-graft thoracic aorta with distal stent-graftinduced new entry associated (d-SINE) in the long-term follow-up period in comparison with a widely used technique of measuring diameters of the aorta on different levels.Materials and methods. Sequential analysis of CTA in a 7-year follow-up was performed. Aorta was divided into 3 segments, in each segment total aortic volumes (AV), volume of the true canal (TC), and volume of functional lumen of the false canal (FLFC) were calculated. The following were mathematically calculated: volume of the false canal (FC) via difference in volume between AV and TC, volume of the thrombosed lumen of FC as the difference between FC and FLFC, the coefficient of FC thrombosis, the degree of stent-graft opening. Mathematical assessment of excess volume of the graft was performed.Results. Modelling of aortic cavity, evaluation of changes in the volumes of TC and FC during a long-term follow-up, analysis of the factors inducing the development of the d-SINE syndrome were performed. When comparing the volume of the graft and the volume of the implantation zone, an excess of 234% was found, while the opening of the graft was 80%. When using the reference method based on the diameter of the true lumen of the aorta, the excess was 22% during one-year follow-up period showing no changes subsequently.Conclusion. Potentially, the method of measuring volumes based on CTA results can be used to complement the generally accepted method based on measuring diameters, since it does not require additional financial resources and has the potential to estimate effectiveness of treatment and identify complications predictors in the postoperative period to determine indications for reoperation.

Objective: Identification of the quantitative characteristics of changes in the arterial wall according to ultrasound, CT and MRI; development of the roadmap for the use of radiology diagnostic methods.Material and methods: 548 studies of 483 patients with atherosclerosis were analyzed (15 ultrasound studies, 483 – CTA and 50 – MRI). In the comparison group (n = 17) in patients without atherosclerosis, an analysis of MRI data of the aortic wall was performed. According to CTA, signs of atherosclerotic degeneration were assessed. According to the MRI data, indicators of aortic distensibility, Young’s modulus of the aortic wall (MPa), systolic distension of the aorta (ml), aortic wall enhancement index during contrast enhancement were calculated.Results: During the performance of ultrasound in all cases (n = 15), the analysis of the elastic properties of the aortic wall is difficult due to the artifact from calcification. Adverse CT signs of the occurrence of intraoperative vascular complications: the presence of an intraluminal thrombus, an uneven internal aortic contour of more than half of the circumference with an aortic wall thickness of more than 5 mm. According to MRI data in patients with atherosclerosis, aortic distensibility was reduced to 14.42 ± 2.95%, Young’s modulus for the aortic wall was 0.77 ± 0.26 MPa, the index of contrast enhancement of the aortic wall was 1.73 ± 0.5, the volume of systolic aortic distension was 11.48 ± 1.84 ml. In patients with vascular events in the perioperative period, systolic aortic dilatation was 9.2 ml.Conclusion: The signs which are expedient to consider when making a decision on surgical treatment have been identified. Significant limitations were identified in the assessment of elasticity by ultrasound. The wider use of MRI in atherosclerotic lesions looks promising.

Coronavirus disease 2019 (COVID-19) is a poorly understood and dangerous medical problem. COVID-19-related pulmonary vessels involvement is a complex set of interrelated pathophysiological processes associated with vascular endothelial dysfunction and accompanied by thrombosis of various localization, vasomotor disorders, severe respiratory failure, as well as pulmonary embolism (PE) resulting in chronic thromboembolic pulmonary hypertension (CTEPH). According to computed tomographic pulmonary angiography, the incidence of PE in patients with COVID-19 ranges from 23 to 30%. The aim of this work was to focus the doctors' attention on the risk of pulmonary hypertension in patients after COVID-19. Despite the ability of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) to infect various organs and systems, the main and most serious complications are pulmonary infiltration, acute respiratory distress syndrome, acute respiratory failure and PE, which in some cases becomes the triggering mechanism for CTEPH development. The literature review presents data on main pathological abnormalities developing in target organs during COVID-19 and playing an important role in increasing the CTEPH risk. The paper describes the main methods of instrumental investigations of CTEPH and an algorithm for its use in COVID-19 survivors. The revealed data demonstrated that the absence of obvious signs of pulmonary hypertension/CTEPH, the cardiopulmonary system abnormalities cannot be ruled out. Therefore, it seems appropriate to actively follow up COVID-19 survivors. A thoroughly, purposefully collected anamnesis, pulmonary function tests and stress echocardiography in an ambiguous clinical situation will play a leading role as they identify cardiopulmonary disorders and provide the doctor with basic information for further planning of patient management.